The Dim-Post

March 2, 2016

Drug funding and political conventions

Filed under: Uncategorized — danylmc @ 8:15 am

One of the (many) elements to the Key government’s success is its strategic acumen, and a big part of that is its willingness to break with political conventions when it is tactically advantageous to do so.

Like, there used to be this political convention that Pharmac was apolitical. It got to make highly contentious decisions about which drugs and treatments got funding and which didn’t on an empirical basis, and the drug companies were left howling at the door. Or, rather, funding covert PR campaigns featuring terminally ill people who, it was claimed, their new and extremely expensive treatments could save, but which yielded nothing because the funding decisions were walled off from political intervention by long-standing convention. It worked brilliantly because both political parties accepted that having a highly effective drug funding regime was more valuable than short term political point-scoring.

But back in 2008 Key decided it would be worth a few votes to break that convention and pledge to fund Herceptin, a drug for which there’d been an ongoing lobbying and PR campaign. Now, today, Labour is in opposition and is playing exactly the same game with another expensive cancer treatment. So Key has said that he regrets making an exception for Herceptin. Which, possibly he should have thought of before he made the deliberate decision to tear up a long-standing political convention.

It’s small potatoes though, because the sheer scale of the conventions broken by Key because doing so was advantageous (at the time) is dizzying. All the handouts and sweetheart deals and the by-election bribes in Northland and using the police and litigation to attack media critics and the near total politicisation of the OIA process and public service in general are all breaches of political convention. And they’re all very strategically astute. And all the commentators and editorialists have tutted over all of them, but there’s been no political price for any of the breaches of convention or tut-tutting by editorialists or commentators because voters don’t pay attention to any of those people any more.

But the thing with political conventions is that they’re either honored or they ain’t. Having opposition parties that are constrained by conventions but a government that breaks them whenever its convenient isn’t a thing. Which is why Labour are cheerfully campaigning for Keytruda funding and why they ‘broke with convention’ and spoke out against the TPPA and so-on. And the same goes for government. Labour have absolutely no incentive to go into government and fix the OIA process and de-politicise the intelligence agencies and police force, and play fair with their media critics and refrain from bribing the electorate with taxpayer money. Why should they?

If National can break all the rules whenever they want and still remain insanely popular then the other parties can too. Which is a shame, I think, but that is the new political reality that Key and his government have created.

42 Comments »

  1. My understanding is that National blundered into the Herceptin thing. Pushed by the drug companies lobbyists and breast cancer sufferers, junior MP Jackie Blue announced a National government would fund Herceptin on a different basis to that decided by Pharmac. This took off massively in the media (it was newsworthy for its own sake and because of the break in the bipartisan convention you write off) and so it was then decided it would not be possible to go back on it without looking (a) heartless and, more importantly, (b) incompetent and thereby risking winning the forthcoming election. I suspect Labour got to its Keytruda place in a similar way. It is just implausible that their health policy czar Annette King would agree with overruling a Pharmac decision.

    Comment by Matthew Hooton — March 2, 2016 @ 8:31 am

  2. Nobody is forcing Labour to act in such a stupid manner.

    Someone could have reacted as Hague has done but they chose not to.

    It’s emblematic of where Labour is – they can’t be bothered or no longer recognise the need to put forward the more difficult greater good argument.

    Comment by NeilM — March 2, 2016 @ 8:40 am

  3. As opposed to any conventions that the Helen Clark government might have broken. Like perhaps ruthlessly controlling media access to only those who gave favourable coverage. Or changing the electoral act for political advantage. Sorry, pot and kettle stuff here. The reality is that most of these conventions are only conventions when people care about them. And if you break them with no consequences, then you’ve done well. And if you break them and people complain, you take the punishment.

    The interesting bit is the way the National govt have said “we regret doing that” and people believe them. And I’m not sure that people are buying Labour’s campaign on Keytruda.

    As for TPPA – Labour actively supported the agreement, and actually initiated it. And said they wouldn’t reverse it in power. They don’t even have a principle that they’re trying to uphold, there’s not a lot to respect there.

    Comment by PaulL — March 2, 2016 @ 8:40 am

  4. “…Nobody is forcing Labour to act in such a stupid manner…”

    I can only hope someone has a gun to you head, our you are just a moron.

    Comment by Sanctuary — March 2, 2016 @ 8:43 am

  5. There is incentive to strengthen the OIA – because National will be in power again and it would build trust in a new government to do it. But over the term of the next leftwing government it will make their job harder and so they probably won’t do it, to all of our detriment. The same applies with intelligence agencies etc.

    I’m not sure it would be possible to legislate for any of those things and the cabinet manual seems to be only nominally binding.

    Comment by RHT — March 2, 2016 @ 9:12 am

  6. @Hooton “My understanding is that … “

    So that would be code for “what follows is bullshit with no basis in fact?”

    Comment by RJL — March 2, 2016 @ 9:12 am

  7. Controlling media access and passing electoral legislation aren’t conventions like those Danyl is talking about. The latter was mishandled but it at least was done through the legislative process and imposed the same rules on everyone.

    The TPP that Labour initiated excluded Japan and the US, which meant it was actually a good free trade deal (i.e.without the US imposing its laws extraterritorially and mutual trade concessions).

    Comment by RHT — March 2, 2016 @ 9:17 am

  8. Nobody forced National to do it either, but they did. At any event Danyl is right. You can’t blame Labour for copying National’s playbook.

    Comment by Nick R — March 2, 2016 @ 9:38 am

  9. All this breaking of conventions looks like the actions of insecure dictators. This debate points to a greater philosophical question – why are the secular who think we are just a collection of chemicals and electric circuits and often in favor euthanasia so frightened of dying? It gets us all eventually.

    Comment by Brown — March 2, 2016 @ 9:44 am

  10. The TPP that Labour initiated excluded Japan and the US…

    The US entered the trade talks in Jan 2008 while Labour was still in office.

    Prior to that US was not involved not because they were excluded but because they chose not to.

    The intention according to Goff was always to bring the US in.

    You can blame Labour because it should be against their principles to undermine Pharmac.

    If the major centre left party doesn’t even attempt to make a difficult moral argument to the public then there really is no point in having a centre left.

    Comment by NeilM — March 2, 2016 @ 9:46 am

  11. This

    “… using the police and litigation to attack media critics and the near total politicisation of the OIA process and public service…”

    seems to err on the side of over-excitement.

    Comment by Liam H — March 2, 2016 @ 9:53 am

  12. And all the commentators and editorialists have tutted over all of them, but there’s been no political price for any of the breaches of convention or tut-tutting by editorialists or commentators because voters don’t pay attention to any of those people any more.

    Well, I’ll just slink off back to my bedroom, pull the covers over my head and weep quietly into my pillow, then. My delusions of relevance lie in a shattered heap on the ground.

    Comment by Andrew Geddis — March 2, 2016 @ 10:12 am

  13. This

    “… using the police and litigation to attack media critics and the near total politicisation of the OIA process and public service…”

    seems to err on the side of over-excitement.

    See! David Farrar’s breaching of blogger convention in respect of the EFA means that danyl no longer has any reason to respect them now that National is in Government … .

    Comment by Andrew Geddis — March 2, 2016 @ 10:17 am

  14. Something like 100 patients have to take statins daily to prevent one or two heart attacks per year ( for that group of 100).

    Looking at Keytruda we can see that survival is measured in a few months extra compared to existing treatments
    ” median PFS was 3.9 months (95% CI, 3.1-4.1) and 4.0 months (95% CI, 2.7-4.3), compared to 4.0 months for docetaxel (95% CI, 3.1-4.2).
    PFS is progression free survival, median means of course half are less than that

    Comment by ghostwhowalksnz — March 2, 2016 @ 11:33 am

  15. It’s much more serious than “they done it, we done it, they started it”.

    Key’s popularity is directly linked to him being the Commentator-in-Chief. If a statement on any issue is made by the relevant official or minister, the media coverage is minimal. Whereas Key’s utterance is an instant headline. This is not just because National play to their strength, it is also the media lacking the resources or will to do donkey work in the brave new celeb world they feed off, and feed. The old way – the one that got us those global rankings we boast – is all too boring.

    The Prime Minister has broken “convention” on anything from the Reserve Bank to the judiciary to the defence force, simply because … he can. The (relatively) good news is that Labour/Green government probably won’t behave as badly, not because they are more noble but because it will be harder to pull off. They might have a majority, but they won’t have a Key. Andrew Little won’t be be able to go “aw shucks, I pissed on the constitution, doncha still love me?”. And nor will the next National leader … well, let’s hope so.

    Comment by sammy 3.0 — March 2, 2016 @ 11:36 am

  16. Looking at Keytruda we can see that survival is measured in a few months extra compared to existing treatments

    So ghost, I can’t tell from your comment whether you are for or a’gin.

    Comment by Gregor W — March 2, 2016 @ 11:59 am

  17. I am not normally a fan, but I must admit Andrew Little’s take on this issue, as I heard it on Morning Report yesterday made a lot of sense to me. Basically that the Pharmac model is a good one, but not perfect. It could surely be tweaked so that NZ is not the last country in the first world to get access to breakthrough cancer treatments. As far as the efficacy of Keytruda is concerned – I am sure you can use statistics to make any point you like – but there’s no doubt that there are lots of individuals who were deemed to have stage 4 melanoma and who are now as far as can be detected cancer free. This is a new and exciting development, and the oncologists seem to speaking with one voice.

    (I have been suspicious of po-faced scientists on drug efficacy ever since I saw one state with a straight face that pseudoephedrine had no proven efficacy as a treatment for common cold – This seemed to be a bizarre assertion to me as I have been conducting my own scientific experiments for many years – viz. any time I was suffering horribly with a heavy head cold I would take pseudoephedrine and find it invariably delivered several hours of blessed relief).

    Comment by Bill Forster — March 2, 2016 @ 12:03 pm

  18. Which is a shame, I think, but that is the new political reality that Key and his government have created.

    This new political reality of which you speak, shares many similarities with old political reality.

    Comment by unaha-closp — March 2, 2016 @ 12:32 pm

  19. Labour have absolutely no incentive to go into government and fix the OIA process and de-politicise the intelligence agencies and police force, and play fair with their media critics and refrain from bribing the electorate with taxpayer money. Why should they?
    Because Donald Trump, that’s why. He has become the malevolent force he is today because the ordinary voter in America is heartily sick of self-serving, bought-and-paid-for politicians who keep doing stuff like that. That said, this was very funny. Sauce for the goose.

    Comment by McNulty — March 2, 2016 @ 12:47 pm

  20. Actually, thinking statistically for a moment, consider this thought experiment: Disease X is universally and uniformly lethal. All victims die precisely one month after diagnosis. The existing treatment is completely useless and has no effect. A new treatment is developed that completely cures 40% of victims. Calculate the median survival time for the new treatment; Start by lining up the survival times of the 10 patients in the study in order; 1 month, 1 month 1 month, 1 month, 1 month, 1 month, 50 years, 50 years, 50 years, 50 years. Median survival time is 1 month, exactly the same as the existing useless treatment. Pharmac rejects funding of the new treatment on this basis. I hope this isn’t how it works!

    Comment by Bill Forster — March 2, 2016 @ 12:48 pm

  21. “It is just implausible that their health policy czar Annette King would agree with overruling a Pharmac decision.”

    Except for when she did exactly the same thing on beta interferon when Labour took power in 2000. See New Zealand Gazette 52:117, 18 May 2000. p1144

    Comment by Dr Foster — March 2, 2016 @ 1:17 pm

  22. The reason Labour is acting like it is isn’t because Key broke NZ politics but because Labour is in competition with NZF and the Greens.

    Labour did have an unspoken agreement with the Nats on such issues as trade and security but they’ve decided to oppose the TPP because they’re worried about the Greens.

    Chinese sounding names – NZF of course.

    This latest on Pharmac just seems more about Little trying to get attention.

    Comment by NeilM — March 2, 2016 @ 1:18 pm

  23. Jonathan Coleman says ” I will be making the case to increase Pharmac’s budget.”
    Well he’ll need to because last year John Key told us the Government will face a higher medicine bill under the TPP

    We will be paying more for currently used medicines making it even more difficult to fund new treatments. Thanks National, brighter future- yeah right.

    Comment by Corokia — March 2, 2016 @ 1:28 pm

  24. Well, I’ll just slink off back to my bedroom, pull the covers over my head and weep quietly into my pillow, then. My delusions of relevance lie in a shattered heap on the ground.

    I didn’t mean you when I talked about commentators who no one listened to anymore, Andrew. You’re a respected professor of law. Voters NEVER listened to people like you.

    Comment by danylmc — March 2, 2016 @ 2:27 pm

  25. I didn’t mean you when I talked about commentators who no one listened to anymore, Andrew. You’re a respected professor of law. Voters NEVER listened to people like you.

    Which is why I have long been opposed to democracy in all its forms. Speaking of which, that Plato fellow knew how to run things … .

    Comment by Andrew Geddis — March 2, 2016 @ 3:42 pm

  26. “there’s no doubt that there are lots of individuals who were deemed to have stage 4 melanoma and who are now as far as can be detected cancer free”
    None of what you say is true!
    Careful of the selected few people who are presented to the media by a ‘support group’. The actual evidence is a tiny amount of extra time over existing treatments.
    There is a whole list of cancers they are waiting to pass Keytruda as a a treatment once they have achieved this one.

    Comment by ghostwhowalksnz — March 2, 2016 @ 3:50 pm

  27. ‘I have been suspicious of po-faced scientists on drug efficacy ever since I saw one state with a straight face that pseudoephedrine had no proven efficacy as a treatment for common cold ”

    So ‘one scientist’ in your study means all others are charlatans?
    Well pseudoephedrine is no longer available as an OCM ( over the counter medicine) and just as well you werent taking phenylpropanolamine as that can cause cranial hemorrhages.

    What you have done is mixed cause and effect, as you own body is doing the fighting inflammation while you just happened to take a pill.
    ‘The cold’ is so complex its virtually impossible to know in time which type or sub type and take the medicine before its all over.

    Curing melanoma or more realistically delaying by a few months end stage progression ( thats deliberate as that is what passes US FDA rules most economically for the drug company) is not that hard compared to finding a cure for the common cold- and which will make you far richer

    Comment by Ztev Konrad — March 2, 2016 @ 5:39 pm

  28. “It’s small potatoes though, because the sheer scale of the conventions broken by Key because doing so was advantageous (at the time) is dizzying”

    This is fantasy.And it is especially fantasy in relation to the OIA. In National the approach to the OIA is determined by individual Ministers. That’s the National culture. Some are liberal and relatively hands off. Others are micro managers and control freaks. Within limits, the law allows both approaches. Labour tried to exercise much more central control and from 1999 the approach taken to the OIA became much more restrictive. Some National Ministers have followed this precedent and others have not. On the whole the overall trend across governments is for more openness not less and National have continued this, especially in the areas of security and intelligence. I think your definition of a broken political convention is “something I disagree with or that disadvantages the Party I support”. It’s an understandable higher form of self pity and reflects the lack of success of the left since Key became National’s finance spokesman in opposition, but self pity it remains.Look, the political wheel will turn and there won’t be a National-led government one day. Turning everything into a plot or conspiracy by one side or the other is just silly.

    Where John Key and his government differs from predecessors is their ability to stick to a strong core strategy and be very flexible or non ideological with anything that does not damage that core. People who want more sign of ideological purity get very frustrated with this and the opposition periodically try to argue that National is Labour lite or left wing lite. The latter reflects both hubris and a terrible send of self awareness, particularly the belief that only the left can have a social policy worthy of the name. Labour’s policy on the flag change issue is a classic of this kind.

    “………but there’s been no political price for any of the breaches of convention or tut-tutting by editorialists or commentators because voters don’t pay attention to any of those people any more.”

    They never did, but oddly the occasional academic – Professors of Law even – were regarded as effective political commentators though, like newspaper editorials, they were only addressing small audiences. The only commentator/columnist to ever reach a large audience was the not yet late but definitely great Tom Scott whose column and occasional articles in the Listener were must reading for an extremely wide audience, from young to old. That’s mostly because he was very funny and his talents had the ideal subjects in two larger than life cartoonish Prime Ministers to write about in Robert Muldoon and David Lange. He also had a very tough editor in Ian Cross who protected him from political wrath.

    Comment by Tinakori — March 2, 2016 @ 6:49 pm

  29. Ok you’ve got me. Clearly pseudoephedrine was never an effective decongestant and I was imagining the relief I wasn’t actually getting for a few sweet hours immediately after taking the drug. (Incidentally I remember Danyl writing about this very subject on this very blog far more incisively than I ever will). And obviously Keytruda and the other new generation immunotherapy drugs are essentially completely useless and definitely don’t offer any hope where none existed before. Median survival time is obviously an extremely effective metric and immune to the distortionary effect I demonstrate in 20 above. Clearly public health bodies in the UK, Canada and Australia are delusional and every oncologist I’ve heard discussing the subject is a foolish charlatan. Thanks for clearing all of that up.

    Comment by Bill Forster — March 2, 2016 @ 6:57 pm

  30. Andrew Geddis: “Speaking of which, that Plato fellow knew how to run things … ”

    Philosopher kings, wasn’t it? I wonder how that’d pan out. Though I’ve known some very smart philosophers: it’s just that intellectual heft seems to be neither a necessary nor sufficient condition for success as a ruler, whether or not of the kingly variety.

    Bill Forster: ” Clearly public health bodies in the UK, Canada and Australia are delusional and every oncologist I’ve heard discussing the subject is a foolish charlatan.”

    Indeed; my sentiments exactly.

    The Herceptin argument was, as I recall, about how long a course Pharmac should fund, not whether or not it would be funded. In the case of Keytruda, it comes (or not) into an environment in which there is no effective treatment beyond excision of melanomas in the very early stages, before there has been any spread of the cancer cells. As things stand right now, once the lymph nodes are affected, one might as well go home and put one’s affairs in order.

    I’m unable to be dispassionate about this issue: like many New Zealanders, I’ve had friends and family die of malignant melanoma. It’s a cruel disease, that takes people very quickly – unless diagnosis is in the very early stages. Then they might get a bit of a reprieve.

    In my view, the justification is greater for government intervention on Keytruda than it was for Herceptin.

    Comment by D'Esterre — March 2, 2016 @ 10:44 pm

  31. If National can break all the rules whenever they want and still remain insanely popular then the other parties can too. Which is a shame, I think, but that is the new political reality that Key and his government have created.

    This is nonsense for Labour is not insanely popular, and is not winning favour with it’s promises. I think Danyl projects his own opinion and dislike of Nationals behaviour onto a theory that Labour has the same advantages.

    National gets away with what it does because it is the popular choice, it does not become popular for doing it, and National is kept popular by comparison to it’s opposition.

    Comment by Fentex — March 3, 2016 @ 8:36 am

  32. That’s quite a well made point.

    Comment by Liam H — March 3, 2016 @ 9:10 am

  33. So for the record we all agree that bribing voters with taxpayer money was invented by National for the Northland by election? Nobody’s gonna disagree with that? Well, OK then.

    Comment by Ortvin Sarapuu — March 3, 2016 @ 9:22 am

  34. “Clearly public health bodies in the UK, Canada and Australia are delusional”- of course not, just better funded.

    We spend around the NZ$800-900 mill mark while Australia’s equivalent the PBS has a budget in the A$6.5 bill area. So its around 7x the budget not accounting for currency differences but around 5.25 x the population.

    Remember too Australia has only provisional approval for a 7 dose treatment for Keytruda as they are still evaluating ( as is NZ) the clinical trails to see if its a worthwhile drug. The cost of Keytruda for the limited period is $A111,000.. Australia and NZ do have a melanoma problem, which is only miniscule in the UK so that may be a factor for the UKs decision but they have pulled funding for a range of other cancer drugs “to pay for it” but the wording of their approval seems to be for ‘promising’ drugs that in most cases dont work but a few show great improvement.

    Comment by Ztev Konrad — March 3, 2016 @ 9:50 am

  35. conducting my own scientific experiments for many years

    You’re illustrating exactly what’s wrong with anecdata as opposed to actual trials:

    One data point, you knew you were taking the drug (as opposed to placebo), self-reported (as opposed to measured) effects and a cold is a self limiting condition in any case – so if you ate pine cones, your cold would get better and you might attribute this to their curative properties.

    Comment by richdrich — March 3, 2016 @ 2:35 pm

  36. Do you the commenters on here actually read the comments they respond to? Richdrich is the second one who seems to think I claimed pseudoephedrine cures the common cold. I am not stupid, that would be an extraordinary claim that would required extraordinary evidence, not anecdata. As I stated very clearly, it provides temporary relief. This is hardly a controversial position, no more controversial than claiming aspirin provides temporary relief from mild headache. The po-faced scientist I referred to was the one making a demonstrably absurd claim. My reference to my own personal scientific experiments was provided for humour, although in fact there is nothing to stop the intelligent layman doing effective amateur science.

    Comment by Bill Forster — March 3, 2016 @ 4:00 pm

  37. My reference to my own personal scientific experiments was provided for humour, although in fact there is nothing to stop the intelligent layman doing effective amateur science.

    I think the point was that you didn’t do “effective amateur science”, and what the “intelligent layman” thinks is “scientific investigation” often is nothing of the kind.

    Comment by Flashing Light — March 3, 2016 @ 6:38 pm

  38. For Christ’s sake I know I wasn’t doing effective amateur science, I was joking. The point is that pseudoephedrine is an effective decongestant, it provides temporary symptomatic relief for the common cold. Unless you dispute that you have no argument with me.

    For the sake of completeness I will point out that effective amateur science involves researching a subject of interest, constructing a hypothesis, designing an experiment to test the hypothesis, conducting the experiment, taking careful notes, and analysing the results. If you don’t believe me, listen to zombie Feynmann at https://xkcd.com/397/ I could have done some amateur science with my common colds and pseudoephedrine, but by not taking any notes or doing any real analysis I suppose I was choosing not to. What I couldn’t have done, because I don’t have the resources, training or motivation, is conduct rigorous clinical trials according to accepted best practice. That’s completely different from saying I couldn’t have done any science at all.

    Comment by Bill Forster — March 3, 2016 @ 9:59 pm

  39. Labour are also calling for more $$$ for Pharmac –

    “Pharmac did not receive the funding it asked for in the last budget to purchase new drugs, when there was “huge demand” for access to new pharmaceuticals, King said.

    ‘We’re not just talking about Keytruda, we’re talking about dozens of other pharmaceuticals that are waiting to be funded.” From Stuff today.

    Everyone including the Minister is saying Pharmac needs more money. Better managers of the economy would’ve have realised that sooner rather than waiting for it to become a journalistic firestorm.

    Comment by Myles T — March 4, 2016 @ 12:03 am

  40. God I’m so nostalgic for the good old days of Clark and Cullen. Now, they were politicians I could respect. They would never do the kinds of egregious self-seeking slimey back-handed manipuluative double-dealing that Key does and appears to get away with because he’s just so damn popular. You know, when I was a boy, politicians were real politicians. You could trust them. They abided by conventions because well, they were just more honest. They said what they meant and meant what they said. Not like this new lot. Who you can’t trust them with their ‘popularity’. They think they are God’s gift. WHy won;t people understand? You can’t trust John Key. Read my lips people! you just can’t trust him. And now he’s gong too far. He’s actually contaminated the whole political landscape with his cancerous and corrosive influence on previously high standards of decency and political rectitude. The bastard. I’ve got a good mind to leak details of is conversations to the press, hack his computers to get the ‘evidence’ for the greateer good, and then initiate some drive to enact some jolly robust retrospective legislation to make sure he is punished.

    Not like wen I was a boy.

    Or something.

    Comment by leeharmanclark — March 4, 2016 @ 7:57 am

  41. But seriously, and silly jibes aside, is the post by Danyl a conclusive epitaph on some kind of glorious past? Personally I don’t think it is. The interesting thing for me is how it is symptomatic of a rising, often emotional and vocal dislike of the present lot, a bit like it got about one elections before people tired of Clark and Cullen. To me they are all the same – and Lord Acton pretty much nailed it with his famous words.

    Comment by leeharmanclark — March 4, 2016 @ 8:05 am

  42. …In the case of Keytruda, it comes (or not) into an environment in which there is no effective treatment beyond excision of melanomas in the very early stages..

    This is part of the hype: there is no alternative but the reality is different ie Stage IIIA: The 5-year survival rate is around 78%. The 10-year survival is around 68%

    Thats because there are many many treatments

    eg “No clinical trial has yet shown that pembrolizumab increases the length of life for melanoma patients compared with other new melanoma treatments or standard chemotherapy.”

    Its clear that some people have been conned hook line and sinker

    Comment by Ztev Konrad — March 4, 2016 @ 12:07 pm


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